Medicare in Maryland

Old Line State is among states with lowest Advantage enrollment

Resources for Maryland beneficiaries

State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.

In Maryland you can reach SHIP at 1-800-243-3425 or online here.

Snapshot of Medicare in Maryland

Total Medicare enrollment in Maryland

As of November 2018, there were 1,014,267 Medicare beneficiaries in Maryland. That’s less than 17 percent of the state’s population, compared with a little more than 18 percent of the United States population enrolled in Medicare.

There are more than 60 million people with Medicare coverage nationwide. Alaska has the fewest, at 97,915 and California, which has about an eighth of the country’s population within its borders, has the most at more than 6.1 million (about 15 percent of its population). This doesn’t count the US Territories, which mostly have low total enrollment in Medicare (the Northern Mariana Islands had just 2,075 Medicare enrollees in 2015, although Puerto Rico had nearly 757,000).

Read about Medicare’s open enrollment period and other important enrollment deadlines.

Breakdown of the aged vs. disabled

Individuals who qualify by virtue of their age alone made up 86 percent of Maryland Medicare recipients in 2016. The balance — 14 percent — are on Medicare as the result of a disability.

KentuckyAlabama, and Mississippi had the highest percentage (23 percent) of their Medicare beneficiaries eligible due to a disability, while Hawaii had the smallest percentage at 9 percent. If we consider the US territories as well, American Samoa has by far the highest percentage of beneficiaries eligible due to disability (31 percent), and the Virgin Island are tied with Hawaii for having the lowest percentage of disabled Medicare beneficiaries.

Medicare spending per recipient

In 2016, Original Medicare spent an average of $9,560 per beneficiary in Maryland,  according to data that were standardized to eliminate regional differences in payment rates. The analysis did not include costs for Medicare Advantage enrollees — but Maryland has a much lower-than-average proportion of its Medicare beneficiaries enrolled in Medicare Advantage.

Louisiana had the highest per-capita Medicare spending, at $11,399, while Hawaii had the lowest, at $6,441.

Medicare Advantage in Maryland

Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). Some Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap. In short, there are pros and cons to either option — Medicare Advantage or Original Medicare plus supplemental coverage.

Medicare beneficiaries can switch from Medicare Advantage to Original Medicare or vice versa, each fall during the annual open enrollment period (October 15 through December 7). And as of 2019, there’s a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Nationwide, about a third of all Medicare beneficiaries were enrolled in private Medicare Advantage plans as of 2017. But just 11 percent of Maryland Medicare beneficiaries had selected Medicare Advantage plans. Most of the rest were covered under Original Medicare, but some Maryland Medicare beneficiaries have Medicare Cost plan coverage.

Insurers tend to sell Medicare Advantage plans in localized areas, with coverage availability varying from one county to another. In St. Mary’s County, Maryland, there is just one Medicare Advantage plan available in 2019. But in Baltimore County and Montgomery County, insurers are offering 23 Medicare Advantage plans in 2019.

Minnesota is the only state where more than half (56 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. On the other end of the spectrum, Alaska has just one percent of its Medicare beneficiaries enrolled in Medicare Advantage (and there are no Medicare Advantage plans available for individuals in Alaska; the enrollees with Medicare Advantage plans have them via employer-sponsored plans).

Medigap in Maryland

Original Medicare (ie, Medicare Parts A and B) provides fairly comprehensive coverage, although outpatient prescription drugs aren’t covered unless the enrollee also has Medicare Part D coverage. But out-of-pocket costs under Original Medicare are not capped, and can add up to a significant amount if an enrollee has ongoing medical needs. This is where Medigap plans come in, supplementing Original Medicare by covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise have to pay if they only had Medicare Parts A and B alone.

There are federal rules that apply to Medigap plans, including standardization (there are ten plan designs available, plus a high-deductible version of one of the plans). Federal rules also give Medicare beneficiaries a six-month window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.

In Maryland in 2019, there are 49 insurers that offer Medigap plans, although some only offer a few of the ten plan designs.

Although federal rules don’t guarantee access to Medigap plans for people under age 65, the majority of the states have implemented rules to ensure at least some access to Medigap plans for disabled enrollees under age 65, and Maryland is among them. Medigap insurers in Maryland are required to offer Plan A (and Plan C, if the insurer offers that plan) to enrollees who are under 65, on a guaranteed-issue basis if the person applies for the Medigap plan within six months of enrolling in Medicare Part B. The premiums are higher for enrollees under age 65, although they are given another enrollment window when they turn 65, so they can then switch to lower-cost Medigap coverage at that point, or pick a plan other than Plan A or C.

Stand-alone Medicare Prescription Drug plans

Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription plan.

As of November 2018, there were 526,518 MarylandMedicare beneficiaries enrolled in stand-alone Part D prescription drug plans. That’s about 52 percent of the state’s total Medicare beneficiaries, as opposed to about 43 percent of all Medicare beneficiaries nationwide enrolled in stand-alone Part D plans. But stand-alone Part D plans are typically used to supplement Original Medicare, since most Medicare Advantage plans include Part D coverage. Since enrollment in Original Medicare is higher than average in Maryland, it makes sense that enrollment in stand-alone Part D plans is also higher than average. But in addition to the people with stand-alone Part D coverage, more than 100,000 Medicare beneficiaries in Maryland have Part D coverage as part of their Medicare Advantage coverage.

Maryland had 475,791 Medicare beneficiaries – about 51 percent of the state’s total – enrolled in stand-alone prescription drug plans in 2015. The state has 24 plans with premiums ranging from about $18 to $87 per month.

Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers. But by the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries, including those who have Part D coverage as part of their Medicare Advantage plan).

Health insurance in Maryland if you’re not eligible for Medicare

Are you under 65 years of age, or otherwise ineligible for Medicare? We have information on Maryland health insurance and the Maryland health insurance marketplace at our health insurance site.